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ease was not annihilated by one injection, the man
was imbued with a false idea as to his true condi-
tion.
Dr. match 21 card game Frederic S. Mason, of New York, stated
that while salvarsan might not be as good as mer-
cury, when it was used the acute symptoms were
relieved quickly. He mentioned the case of a wom-
an who had the acute lesions of syphilis and was
attending to her business; she received injections
of salvarsan, and within a week match play 21 blackjack game practically all the
lesions disappeared. This was the principal ad-
vantage in using this agent.
Dr. S. Grovi:r Burxett, of Kansas City, Mis-
souri, reported a case of acute delirium following
the chloroform habit.
Difficulties Encountered in Late Operations
for Intestinal Obstruction. — Dr. Herman E.
Pearse, Kansas City, Missouri, said that by observ-
ing the following procedures the late cases of in-
testinal obstruction could be saved: i. By empty-
ing the bowel at first operation and allowing time
to recover from to.x;emia before resection was
practised, unless gangrene should forbid. 2. This
should be done by employing the long intestinal
tube and emptying the distended bowel as the first
step after finding the obstruction, closing royal match 21 blackjack machine the wound
after providing escape. 3. By the use of a glass
tube of Paul or the rubber tubes with depressed
external grooves, as advised by Andren I\Iarro, to
convey the toxic f3ecal matter beyond the wound,
thus securing primary 'union and safety from ab-
scess. 4. By bringing the bowel edges out of the
incision beyond the skin and substituting the open
treatment by a nurse and water washing for the
closed method of filthy gauze and play royal match 21 online pads of cotton.
5. By employing a second and even third operation
to complete the work when the patient had recov-
ered from the effects of the obstruction and vomit-
ing.
Dr. John E. Summers, of Omaha, stated that
sometimes in cases of strangulated hernia, where
gangrene was present, one could establish an arti-
ficial anus by cutting into the gut, allowing it to
remain there fastened until the circulation was re-
established, and then an operation could be done
later. If drainage was carried out, it was wise to
wash out the gut through a tube.
Dr. C. Lester Hall, of Kansas City, Missouri,
differed with the essayist in regard to the incision.
He said we could open the abdomen more widely
and freely and reach parts of the abdominal cavity
better through a median incision, and there was
less trouble through that incision in the after treat-
ment, and union was better there than in any other
part of the abdominal wall.
Dr. O. Beverly Campkell, of St. Joseph, agreed
with the essayist that a good place to make the in-
cision was about the border of the right rectus, be-
cause there was more trouble in the right side in
intestinal obstruction than anywhere else, and the
fact that one wanted to drain in the median line.
Therefore, he would favor the incision at this place
in most cases.
Dr. S. H. Smitii, of Omaha, reported a case of
intestinal obstruction in a woman. The obstruction
was caused by three constricting bands around the
sigmoid flexure. These bands were cut. There
were adhesions around the cascum which were
broken up. Three days after the operation the pa-
tient had natural bowel movements without the use
of purgatives.
Dr. "F. H. Clark, of El Reno, remarked th-;t
shock in abdominal operations came more from the
rough handling of the intestines than from any
other single thing that entered into surgical work
in the class of cases under discussion. A prominent
surgeon told him not long since that he attributed
his remarkable success to two things : First, he
had acquired a technique which enabled him to get
in and out of the abdomen in a much shorter time.
and, second, he had learned to handle the intestines
just as gently as it was possible to do so.
Dr. John P. Lord, of Omaha, stated that when
there was a gangrenous gut to deal with, he be-
lieved it should be excised ; then we would have an
open bowel and could drain. We should not pack
it with gauze and cover it with rubber tissue. The
r\Iurphy button tempted one to make an immediate
anastomosis, which would be the means of causing
the patient to suff'er from a toxaemia that killed so
many patients that had so called secondary shock.
He did not believe in secondary shock unless it was
a secondary haemorrhage.
Dr. S. G. ZixK, of Leavenworth, Kansas, report-
ed three cases of fa;cal impaction, and said he had
found that by using a twenty-five per cent, solution
of hydrogen peroxide, and putting the patient in
the knee chest position, or exaggerated Sims po-
sition, with the head low down, one or two injec-
tions of eight ounces, followed by irrigation, would
break up these fjecal masses.
Dr. C. H. Wallace, of St. Joseph, said that for
the average surgeon, who met these cases only oc-
PROCEEDINGS OF SOCIETIES.
"53
casionally. he was satisfied that the simpler method
of dramage by play spanish 21 match dealer online free the introduction of a large tube
would result in a greater saving of life than more
extensive work.
Dr. J.\C0B Geigf.r, of St. Joseph, remarked that
early and correct diagnosis was most important. It
was' easy to say what to do, but every case was a
law unto itself^ and when the surgeon had a case
of acute intestinal obstruction and opened the ab-
domen and saw the patholog}', then he had to use
his match play 21 brains to determine what was best to do.
Dr. \'. L. Tkeyxor. of Council Blutifs, Iowa, be-
lieved that if efforts how to play royal match 21 were directed toward a more
certain and early diagnosis, it would simplify the
treatment of these cases very materially. He did
not like to hear the internists criticised for so called
neglect when the surgeon himself was sometimes
incapable of making a diagnosis when he was called
early.
Dr. C. C. CoxovER, of Kansas City, Missouri,
stated that modern methods of diagnosis had been
improved so wonderfully in the past four or five
years that most internists could make a diagnosis
of intestinal obstruction, and they did not need to
wait and call in a surgeon to tell them what was
the match play 21 odds matter with the patient.
Dr. H. M. match play 21 blackjack game Cl.\kk, Platte City, Nebraska, ob-
served that when country practitioners called in
surgeons and thej- operated in cases of intestinal
obstruction and lost forty or fifty per cent, of them.
he thought the practitioner could do nearly as well
himself.
The Rbntgen Ray in Postoperative Cases. —
Dr. R. D. Maso.v. of Omaha, showed the value of
the X ray in cases where operation had been done
and advised its use in all postoperative work where
malignancy was suspected. He pointed out the fal-
lacy of waiting until a return of the tlisease ap-
peared before beginning the use of the rays was
considered.